老年病人应用他汀类药物致丙氨酸氨基转移酶异常的相关因素分析

Infulence of factors related to statin-induced alanine aminofransferase abnormalities in elderly patients

目的回顾性分析老年病人应用他汀类药物致丙氨酸氨基转移酶(ALT)异常的相关因素。方法入选2010年1月至2015年6月于北京大学第一医院老年科住院的服用他汀类药物的老年病人1230例。根据ALT水平将入选病人分为ALT升高组(ALT>40 U/L)与ALT正常组(ALT≤40 U/L),比较2组病人基本资料,合并症,合并心血管用药及其他肝脏生化指标的差异。采用Logistic回归模型分析影响ALT水平的相关因素。结果 ALT升高组79例(6.4%),其中ALT>120 U/L(超过正常值上限3倍)5例(0.4%),ALT正常组1151例(93.6%)。2组在性别比例、合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)、同时应用β受体阻滞剂、口服抗凝药及利尿剂的比例差异均有统计学意义(P<0.05)。二元Logistic回归分析显示,男性(OR=2.33,95%CI:1.168~4.641)、合并OSARS(OR=3.471,95%CI:1.907~6.316)、服用β受体阻滞剂(OR=1.911,95%CI:1.108~3.293)及口服抗凝药(OR=3.638,95%CI:2.020~6.549)与ALT升高有关。ALT升高组的天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)和直接胆红素(DBIL)水平较ALT正常组升高,差异均有统计学意义(P<0.05)。阿托伐他汀10 mg/d与20 mg/d,瑞舒伐他汀钙5 mg/d与10 mg/d引起ALT升高比例差异无统计学意义(P>0.05)。结论在应用他汀类药物的老年病人中,男性、合并OSAHS及合用β受体阻滞剂、口服抗凝药病人ALT升高的风险增加,且合并AST、GGT及DBIL升高。

Objective To retrospectively analyze the factors related to statin-induced alanine aminofransferase （ALT） abnormalities and the changes of potential biochemical markers in elderly patients. Methods A total of 1230, aged 75.5±8.2 years old patients receiving statins treatment hospitalized in Peking University First Hospital during 2010 and 2015 were enrolled in the study. The patients were divided into two groups according to the level of ALT. one group with ALT〉40 U/L and the other group with ALT ≤ 40 U/L. The differences in baseline characteristics, comorbidities, combined cardiovascular drugs, and other liver biochemical parameters were compared between two groups. And then the related factors with ALT level were analyzed by Logistic regression model. Results 79 cases （ 6. 4% ） showed elevated liver enzymes, including 5 cases （ 0.4% ） with ALT level more than 3 times ofupper limit of normal （ULN） （ 〉 120 U/L）. 1151 cases （ 93.6% ） showed normal level of liver enzymes. There were statistical differences （P〈0.05） between two groups in gender, OSAHS, combined with β- blockers, oral anticoagulants and diuretics. Logistic regression analysis showed that male （ OR = 2.33, 95%CI： 1. 168-4. 641 ）, OSAHS （ OR= 3. 471, 95% CI： 1. 907-6. 316）, combined with [5-blockers （ OR= 1. 911, 95%CI： 1. 108-3. 293） and oral anticoagulants （ OR= 3. 638,95%CI：2. 020-6. 549） were positively correlated with ALT levels. And statistical differences in AST, GGT and DBIL were also observed between two groups （P〈0. 05 ）. There were no statistical difference in the proportion of ALT elevation induced by Atorvastatin 10 mg/d or 20 mg/d, or induced by rosuvastatin calcium 5 mg/d and 10 mg/d dose Conclusions The application of statins might increase the risk of ALT elevation in elderly male patients who suffer from OSAHS, taking β-blockers or oral anticoagulants, showing AST, GGT and DBIL elevation.